The Dr Louise Newson Podcast - 062 - Menopause and Contraception - Dr Philippa Kaye & Dr Louise Newson

Episode Date: August 25, 2020

In this podcast, Dr Louise Newson chats to Dr Philippa Kaye - GP, journalist and author. Dr Kaye has just released a new book titled 'The M Word: Everything You Need to Know About the Menopause' and she talks to Dr Newson all about it and explains why she decided to write a book about this area of a woman's life. Dr Newson and Dr Kaye discuss a number of women's health topics in this informative podcast, including safe sex, STD prevention and contraception around the time of the menopause and perimenopause - when you can stop, when you need protection and the different options available. Dr Newson also chats to Dr Kaye about the taboo surrounding women's health in general and why it's important that we change the narrative surrounding the menopause.  Dr Philippa Kaye's Three Take Home Tips about Contraception and Menopause:  You probably need it no matter how old you are! You will need contraception up until 55 depending on when your menopause was and then afterwards as a barrier against STDs. Some of that contraception can be used as part of HRT, such as the mirena coil. Even if you are going or have gone through an early menopause, you may still need contraception. If you have the right menopause treatment and your libido improves, that's great! But we need to make sure we stay safe. 'The M Word: Everything You Need to Know About the Menopause' by Dr Philippa Kaye is available on Amazon and waterstones.com, as well as in most bookstores. www.drphilippakaye.com Find Dr Kaye on Twitter: @drphilippakaye Instagram: @drphilippakaye

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise News Newsome, a GP and menopause specialist, and I run the Newsome Health Menopause and Well-Being Centre here in Stratford-upon-Avon. So today I have Dr. Philippa Kaye with me, who is a GP with a special interest in women's health. And we've decided today to talk a bit about her and her background and her book that she's recently published, which is very exciting. and also we're going to focus a bit on contraception. So welcome, Philippa. Thank you for having me. That's fine. So just before we get really started, tell me a bit about your background and where you work and what you do. So I'm a GP and I work in Northwest London and when I was doing my hospital medicine jobs, I loved all of them apart from orthopaedics. The idea of standing, holding a leg for hours

and surgery did not appeal to me. But I really enjoyed most of them. medicine and therefore GP was the bit that sort of struck out to me as something that I should do. And within that, women, children and sexual health is the part that interests me the most. And the good thing about general practice is that you essentially can choose a little bit what you do. And so that's what I have done. And then I think what came about obvious to me over the past few years was how many women were coming to see me and not being aware that their symptoms could possibly be related to the animals and therefore not asking for help about them. And if they came with one symptoms,

I don't know, let's say they came with hot flushes, if I asked about the other symptoms, which obviously I did, they were often really surprised that actually you could treat them all with one medication or that they all could be related. And I just started to get really sad about how many women I was seeing coming in saying, can I have a memory test? I think I've dementia, how many women whose relationships were in trouble, whose work lives were in trouble, all related to the menopause, and yet not being aware of it, not through their fault at all, because we were taught about the birds and the bees, perhaps by our mums, perhaps by your best mate in the playground, perhaps by a teacher, and you were taught about how not to make babies,

and no one ever mentioned anything. And so it's shrouded in silence, and that means that women aren't really empowered to get the help that they need. And that's why I decided to write the book. Excellent. So just tell us what's your book called. So the book is called the M word, everything you need to know about the menopause by me, Dr. Philip McKay. And the reason that we called it the M word was because when we were sort of thinking about the PR side,

some people were like, you can't have menopause in the title. No one will pick it up. And that will put journalists off straight away. And that will put readers off and it will put bookshops off. And so it's almost like a play in words. the fact that it is so silent and hidden also meant that we had to call it the M word and hide it even within the title. Yeah, which is very interesting, isn't it? Because there is so much stigma. And certainly the word menopause is not a nice word really because I think a lot of people

make some think about middle-aged women, even older women. They think about hot flushes, sweats. And as you quite rightly so, it's not just about those symptoms. And a lot of people still don't understand that it means a long-term hormone deficiency, do they? So they think it's something that as women, we can just get through, we can battle through the worst symptoms and we'll come out the other side to a new phase in our lives. And I think women are made to feel of failure almost if they ask for help, which really saddens and frustrations and frustrating. And I think that that's in a way due to our deal, that it's getting better, but still

fraternalistic society and a hundred years ago, quite frankly, a misogynistic society, that women's health was always shameful. The fact that women bled was considered dirty and something to be ashamed of. I mean, we know that lots of women can't name their genitals and if you can't name them, then why would you look after them? Why would you go for your survival screening test? Never mind get any pleasure from them. And so if there's this idea that women's health is shameful and then it's something that you have to just put up with and most certainly not talk about, never mind go and get help for it. And that's the narrative that really needs to be changed because it's not something that you just have to survive and then sort of be past your peak.

You know, when the deputy governor of the Bank of England is describing the economy as menopausal to mean stagnant and a bit rubbish, well, that's really offensive really, isn't it? Absolutely. Because you're saying that about women, that essentially if you're past the point of fertility, If you're past the point where perhaps, you know, a sort of paternalistic idea of attractiveness changes, then you don't have a point in society anymore. And that's not the case because we live a third of our lives in the post-menopausal state. And quite frankly, I don't want to live a third of my life past my best.

I want to live my best life the whole time. And that's why we have to change the story. Yeah. And that's so interested at a third of our lives being menopausal. So it's not just a little one or two years where we're getting symptoms. it's 30 years and longer for some people, isn't it? Because as some of you who are listening, know, early menopause is very common

and around 1 in 100 women under the age of 40 have an early menopause. So for them, it could be more than 50 years, couldn't it, where they're menopausal? And like you say, for a lot of people, periods, women's health is very negative. And so a lot of people think, well, if they get through to their menopause

where periods stop, they can forget about that sort of women's health side of things, which is completely wrong, because it should be a really positive phase in our lives, isn't it? And as you say, there are millions of women worldwide who are suffering for the wrong reasons, partly because they don't realise the symptoms are related, but also they don't know how to get help. And so certainly reading your book, it's very informative.

There's lots of information about what the hormones do in our bodies. And a lot of people, as you say, don't realize that there are receptors in cells all around our bodies. And like you say, especially in our brains, It's really important, isn't it? So we're so kind to our teenagers, I think, these days. You know, and we excuse the fact that they want to sleep, and we excuse the fact that they're grumpy, you know, and we say, oh, they're just teenagers.

It's their hormones. We're not kind to each other as women, are we? And in workplaces, we're especially not kind. And the idea for many women of going to talk to their line manager who might be a man, just as simple to say, can I have a fan on my desk? Or if you are working in a factory saying, I need to go to the toilet mouth and when I used to.

Now, actually, that's really intimidating because people aren't informed about it. And that's why it's a societal change in a way that we need in order for these things to not be shameful because they're part of life. And actually, being in a post-menopausal state for many women means that they're free from the bonds perhaps of childcare or the bonds of really heavy painful periods that meant that they couldn't function really. And whilst that shouldn't be the case, and I definitely advise you to. go and see your GP, but for many women, that is a reality, or terrible PMS, you know, and actually we're moving into a phase of our lives where that might not be something that is bonding you, and so we should be looking at the stage as a positive stage and not something to be dreaded. Absolutely. And as you know, if you manage the menopause in the right way, and it's an individual's

decision about how you manage your menopause, and it's often a combination of lifestyle changes and hormones for those people that can take it, it can be a really positive experience and a positive new phase in our life. So thinking about positive things, we were going to talk about contraception, and there might be a lot of people listening there who have no libido. In fact, a lady I spoke to earlier in my clinic says she would prefer to clean her oven than have sex because her libido has gone so much, which is funny but sad as well, isn't it? And I speak to a lot of women who say that they pretend they have headaches or they're longing for their husband to go. to sleep and then they'll creep up to bed.

I don't know. Is that your experience talking to menopals or women? I think that lots of menopausal women are very surprised when I bring it up as a potential issue. They say oh, I just thought that was part of getting older. Yeah, my husband's not happy about it or my partner's not happy about it, but I thought that was just a bit expected.

And when I say, well, actually, you know, maybe there's something that we can do about that, they're often very surprised. But what I find really sad is that they're aware that their libido is run off and lots of them are really unhappy about that and they're unhappy about the impact that's having on their relationship and they're saying you know well I'm having sex because I think I should not because I want to and he or she has noticed so even when they're still having because often a

psychosexual sexual sexual will say that women's libido is very different to men even if we take the menopause out of it and for some women actually sex stimulates desire as opposed to the other way around but when it's sort of impacting on your sex life that your partner is saying, I know you're into it. And actually that's really sad because sex is an important part of a relationship. Be that a relationship with yourself or a relationship with a partner, it is important. And we must talk about it and ask about it.

And I think as GPs and as doctors, when we're the ones we talk about it so openly and honestly, and frankly, it opens the floor for women to actually be able to stay what's going on. Yeah, absolutely. And I certainly ask the vast majority of women in my clinic about libido and about sex. And I'm really quite sadden that even though a lot of these women have been back and forth to different doctors or healthier professionals trying to get help, I'm often the first person they've ever spoken to about sex because no one's asked them before. And as doctors, we're not embarrassed talking about sex. We can talk about anything. And women want to talk,

but unless someone initiates that conversation, they're not going to start it. Absolutely. And I've often had colleagues come in, so lots of GPs will do what we call hot dusting, so you might have your surgery for a morning and somebody else has it in the afternoon. And the GP that comes in off to me on a certain day often says to me, gosh, you can't close down your browser, what were you looking at? And I'm like, oh, I don't know what was there? And so it might be that I've seen lots of young girls who are coming in

and they're worried about the appearance, for example, of their genitals. So you can go to the old embarrassing body's website and there's a vulva gallery and sort of see a hundred evolving and baby girls, look, you know, look, they're all different and they're all normal. Or I can be discussing vaginismus, so that a painful involuntary contraction of the vagina, which can stop penetration or even just vaginal adrinism, we can be talking about dilators. And the dilators that you can get on the NHS are these sort of really hard,

plasticy things that don't feel remotely large. A penis does, and they're just really clinical. And yet you can get from various online sellers, ones which are silicon coated, or ones which come either with an internal vibrator or an external vibrator so that you can get a little bit of positive feedback when you're doing the dilation. And so the GP came in and opened on my own browser is Shush Women's Store, which is the women's own sex shop. And that's why I'm there. And it's totally legitimate. and there's nothing sort of odd or wrong about it. It's for a total clinical reason, but GP's a surprise.

And I think, well, if the doctors are surprised, how can the patients get help? And that's why I always bring it up. And it's not necessarily, you know, I'm not doctor bashing at all. We can't know everything about everything, you know. And if you come to my GP surgery and you ask for a joint injection, they're not going to send you to me.

I'm going to send you to the guy down the corridor because we can't all do everything. at once. But yes, I think that sometimes we have to open the floor. And once we do, the floodgates then open from them. Yeah, I think it's very important. And there are all sorts of ways that libido can improve. And for some of you that haven't heard, I've done a great podcast with Sam Evans, who runs Joe Devine and she's very open about different ways of improving libido and relationships, because it is so important. So during the perimenopause. So this is the time around the menopause when women are still having periods,

but menopausal symptoms start. That can be a time when people are often worrying about contraception and often if they're in their late 40s or even mid 40s, it might not be a time that they would consider starting the combined oral contraceptive pill. Or often I see a lot of women who are in their late 40s and are told they have to stop taking their contraceptive pill. And a lot of these women and do not want to become pregnant and they're in their late 40s and early 50s. So just talk us through about, you know, when do you know that you don't need contraception when you're menopausal and what choices are there for those women who are perimenopausal? So for all the women that I see who think, oh, my periods are slightly irregular, I don't need it,

you do, or they think I've got regular periods, but I'm 48, I don't need it, you do, basically, you need it. And even after you've gone through the menopause and let's say you're 65, and then they think, well, I can't have a baby anymore, I don't need it. You do? Because if you're having sex with new partners, there's still a risk of STDs. And actually, one of the age groups where chlamydia is on the rise is in the over 60s. So you will need a condom to protect you from that. But basically, the rule of thumb is this.

If you go through the menopause and by that, I mean that you have not had a period for over a year, under the age of 50, you have to use contraception for a further two years. If you're over the age of 50, once you've been through the menopoulers and you haven't bled for a year, you have to use it just for a year. And by the age of 55, we can all stop. The risk is considered so low. So it doesn't matter if you're 42, 48, 52, if you're having periods, you need to use contraception. Now, the reason that we see lots of women who run the pill and by the pill, I mean the combined hormonal contraceptive pill,

who are in their 40s and think they have to stop is because the guidance changed. So when I started as a GP, if you were over the age of 35 and you had one risk factor related to the pill. So for example, you were a smoker, you had to come off. And now the rules have changed that have said that you can continue on the combined hormonal pill until the age of 50. And yes, you will have to have a once a year pill check with your GP that will include a blood pressure check. And if you have a combination of risk factors such as smoking, obesity, things like, that, then we might advise you to go on something different. But otherwise, you can have the combined hormonal contraceptive pill. And actually, if women who have gone through premature

menopause, it's a really good choice because it works as a little midge of HRT as well, and because it's got some estrogen in that. If you can't have the combined pill or for some other reason you're not keen on it, then the next form of oral contraceptive is a progesterone-only pill. And that's suitable, for example, if you have that we call focal migraines, then that means that you can't have the combined pill. There's two kinds of that. The older kind you have to take within the same three-hour window every day. But the more modern kind you just take every day continually.

Some people will not bleed on it at all, and some people will bleed regularly, and some people will bleed more regularly. But all GPs love long-acting reversible forms of contraception. And the reason that we love it, we call it Lark, is because you don't have to do anything. Once it's in, you can forget about it. And when we remove the use.

user from any form of contraception, the efficacy rate goes up. So if you don't have to remember to take the pill, which you might forget, if you don't have to remember to put the condom on, which might break, then the efficacy of your contraception goes up. And actually, you can use most of all of those during the menopause. And there's various different types. The first type is an injection. That actually the most modern one, you can be talked to give yourself, or you go into your practice nurse and you get that every three months and that's progesterone only. The second kind is an implant. It's about the size of a hair grip and it sits underneath your upper arm and generally you

can't see it at all and that can last for up just three years. And then we have two kinds of coil. We have the non-hormonal claw which is the copper coil and if your periods are heavy or if they're getting heavier in the perimenopause then that probably is not the best choice because it can make your periods heavier. but it does work for some people who have very light periods. Or we have a hormone coil. There's various kinds of hormone coil,

but one in particular called the Myrina can last up to five years. And the advantage of that is that it can be used as a progesterone part of HRT if you were to go on to HRT. So there are lots of options available. And actually, if you are taking an injection and implant a coil, you're using far less progesterone, far less hormone than you would do if I give it to your orally. If I give it to you orally, it has to go through the liver and the liver is trying to detox and get rid of everything. And so if you want to use the smallest amount of hormone, then the progesterone coil is the way to go. The progesterone core is the only one of those

progesterone methods that can be used for the progesterone part of HRT. And for many women, you know, that's the answer. So we definitely need it. And I would say you need to go and talk to your GP about which is the best option for you when you take into consideration. And the rest of what's going on. So if you're having flushes, you know, and sweats or whatever else, and you're thinking, I don't want to take a pill every day, then the combination of a myrina plus some estrogen through the skin is probably a really good option for you. If you're thinking, you know what, I actually like to take a pill every day, I like to have control. I like to have control of when my bleeding's going to happen and I don't have any risk factors, then the combined

pill might be the best option for you. So I would definitely go and have a chat to your GP. but most importantly, you still need to use it. Absolutely. And I think this is really important knowing that there are lots of choices. But I see and speak to quite a lot of women who have a marina coil in, and often that means they don't have periods. And then they're told that, well, you're on hormones, and you're not having periods, so you're probably menopausal,

so you don't need anything else. Right. So although the guidance is very clear that over the age of 45, if you're having symptoms that you don't need to have blood tests, Some forms of contraception will interfere with those blood tests. So if you're on the combined pill, it will interfere with the blood test if you're 42, for example. But others don't. So if you're on my arena quo, for example, we could, if you're under the age of 45,

we could take blood tests to see whether or not you were perimenopause. But if you're over the age of 45 and you're symptomatic, the progesterone is not the hormone that is necessarily taking your symptoms away. So you need to be sure that we're covering all our bases with which hormone we need. And so the progesterone coil is not going to be enough if lifestyle measures, etc, are not working for you. Absolutely. And I think that's really important. And the blood test that's sometimes done the follicle stimulating hormone, the FSAH blood test can be quite unreliable, can't it? Because it can vary throughout the day and also throughout days as well. So if someone's experiencing symptoms that have recently occurred and you think may be related often, we do give estrogen with the marina coil. like you so rightly say, and see if people improve. And if they do after a few months,

then you know that it's related to being perimenopausal. And as you say, the marina coil lasts for five years with HRT. So, and then a lot of people, even when they're older, even over the age of 55, and don't need contraception, they can still have the marina coil, can't they? And often they choose to have it because it's often the progester and part of the HRT, that is more likely to give side effects. Now, we have ways of managing that, whether you change to, for example, utrogestine, which is the one that's most like the progester, and even if you were to give that orally, and if you were to have some side effects with it, giving that vaginally decreases the risk of those side effects. But for some women, actually, the fewer side effects,

because we're using the tiniest, tiniest dose of progesterone because it's acting locally in the womb to do what we want it to do, which is to keep the lining of the womb thin. or negligible after the age of about 55. So you're the least likely to get side effects with that, and that means that you can still get the benefit from the eustrogen on top. Which is really important, isn't it? And also the eutja gestan, the micronized progesterone, isn't actually licensed as a contraception, is it? So if someone is not having periods and using eutogestan, then you can presume that it's a contraceptive, but you have to get to that stage and see how many periods you miss. So for a lot of people who are perimenopausal, then it's often a more advisable option to use the marina coil as progestrogen, isn't it?

And the other thing is that even if you've gone through premature menopause, especially even younger and younger ages, there can be almost random ovulatory activity. And so you need to use contraception. So people think, well, I want to be the preptial menopause. I'm 25 if I don't need it. But you still do. You still do. Yeah, and certainly HRT, unless you use the marina coil, is not a contraceptive. And for some women who have an early menopause or premature ovarian insufficiency,

actually their facility improves with having HRT because you're adding back a few more hormones. So you have to be ultra careful. And that's why often they will use the combined hormonal contraceptive, because then that will work both as contraception and HRT. Absolutely. And what we increasingly advise, especially young women to do, is to run their pill packets together, don't we? So because if you're only taking the pill for three out of four weeks and you have early menopause,

then it means for a quarter of your time you're not getting any hormones, which clearly is not good for your heart and bones as well. And even if you haven't had an early menopause and you're using the pill, the pill rules have changed and they were set a long time ago when they were set sort of with the idea that women had to have a period and that it was unnatural to not have a period. But the period that you get with the pill is not a period. It's a withdrawal bleed. And we know after many years of using it, for example, people because of their CMS or headaches or things like that, that we started saying, well, run three packs together, people with endometeosis or other conditions.

And then we would say, okay, well, maybe you can run more than that. And so now we're talking about tailored pill taking, which means actually that even, no matter how old you are, if we're using it for contraception, you can run those pills back to back because not having a period in that situation, when we are humanely making that happen is not risky. And so I've got some women who will choose every three months to take a break, and that break can be for four days. It doesn't even have to do for seven days. And for other women, you run the packets until you bleed. Now, for some women, it might be at two months.

Other women, it might be a four months. Other women, it might be a bit longer. And once that happened one time, then you say, okay, so I bet it four months. So at three and a half months next time, that's where I'm going to take my birthday break. And actually, it gives you quite a lot of control. about when you bleed.

And that's why it can work really well. And for women within early menopause, essentially you're then getting much more hormone for as long as you need it. Which is really important, isn't it? I think once people realise that actually it's almost better for us not to have periods because even missionary we're designed to be pregnant most of our lives

so it rest the ovary. And I think this is probably why people who take the pill have a lower risk of ovarian cancer because they're less likely to turn over all those cells all the time. So once people realise it's not proper periods, because a lot of women have this fixated thing that they need to have a period, or the blood's going to build up somewhere in their body. If they take the pill continually, actually it's really good not to have periods.

And like you say, to be in control. Yeah, and they use the word, oh, I need to have good clean out. That's what they say. Which comes back to the idea that feeding is thirsty, isn't it? It's that whole thing about something, about, women's health in your womb and your vagina being dirty and something that needs to have a good clean, which definitely is not true. No, no, totally true.

So before we finish, just let's go back about your book. Just tell me your, why did you decide to do the book? Was it really because of seeing so many women who were struggling with symptoms? It was absolutely because I was seeing women every single week who were, who were, are, I still do, really struggling with the symptoms, but not just in a way that was contained, if that makes sense. So that, for example, when we talk about anxiety, somebody might say, oh, you know, I get anxious when I have to talk in front of other people.

And that's sort of very specific. And then when that anxiety then spills out into the rest of your life, so I can't go to work, so I get worried about going to a party. And that anxiety spilled over. And so what I was seeing is that the effects of the men are. and the symptoms of the menopause were spilling into the whole aspect of women's lives, be it their family lives, their personal lives, their sex lives, their work lives. Something has to be done.

And so that's what was the drive was to write the book. And we have to change that story. And whilst it's amazing that the legislation has changed and that the menopause is going to be part of the PHSC curriculum from September of this year, if the schools ever be open. And if you're listening to this later, we are talking in the middle of the corona crisis from our respective homes, you know, 200 miles apart. But what that means is that you're educating girls who are 11 now. But that means that anybody in the generation of me, my generation,

the generation of donors are not in food. And we have to start talking. And I really hope that the book, the N-word, everything we need to know about the menopause, is the start of that conversation for you. and your friends and means that even if you can go to the key thing and say, I've read about this, do you think that that's right? I never have an issue with that. I think that's great. If somebody comes to me saying, you know, I've researched this. Could this be what my issue is? I think, oh, this is somebody that's actually an ownership of their health and somebody that really

wants to get involved. And that's a good thing. And so I just, I really hope that it helps women. And I hope that it helps start the conversation, be it with your. friends or your family or your partner because quite frankly this book and this conversation is not just for women we might be 51% of the population but the menopause affects 100% of the population because everybody who's a man out there has a mother or a sister or a partner or a friend and therefore everybody needs to be informed yeah and i think that's so important and it is so much about empowering women and certainly with um my website and some of the other work i do it's about enabling women to have a choice and certainly reading a book like yours can really open up that

conversation and I know certainly as the doctor if someone comes and they've got more information on board and more knowledge certainly that's evidence based it can really help that consult and consult and content and certainly for GPs who are very time poor it can really help get to the gritty bits if you see what I mean if they've read absolutely got the information you can then open up the conversation about where you're going with treatment, which is only going to help. And I think it's also being able to read something that people can just learn about things that they might not have thought about. So like you say, they're picking up your book maybe because they've got hot flushes and then they're reading about sex or urine infections or about

brain fog or things that they didn't realize. It's trying to join the dots, isn't it? And I think certainly like yours can really help do that, which has only got to be really. good thing. Thank you. And I think also that for all the people that think, oh, you know, I don't want to read a whole book about the menopause or all. There's going to be a lot of science in there. The skill of being a doctor and the skill of being a GP, I think, is about translating medical ease into English. That's what we do all day, every day, is that we take medical language and we put it in a way that you can understand. And so this isn't a medical textbook aimed at medical professionals. This is a book that is aimed at women. And you can

dip in and out of it. And then there's also section. about looking after yourself after the menopause, about things like screening tests and health after the menopause in general, because as I said, we're living a third of our lives in a postmenopausal state. Let's live them healthy and then happy. Absolutely. Absolutely. So thank you ever so much. It's been really informative. So thank you for spending your time. Before we finish, could you just give us three take-home tips for contraception during this time in our lives? So number one, you need it or you probably need it. So no matter how old you are up until the age of 55, depending on when your menopause was, you're going to need it.

But even after that point, you need a barrier to protect against STDs. And number two, some of that contraception could be used as part of HRT. So that's your myrina coil. And that's the least amount of hormone that we can have. And number three, I would say that even if you have gone through an early menopause contraception is really important because of the risk of pregnancy. And as we said, that it could be used as part of HRT as well. So if you listen to the other podcast and your libido improves, we need to stay safe in order to have good sex lives. Brilliant. Oh, that's such great advice. So thanks ever so much.

Thank you. For more information about the menopause, please visit our website www.menopausedoctor.com.